How to set up hypertension screening program

June 19, 2006

More than one-third of Americans have high blood pressure. Some do not know it; others know it but do nothing about it. Data from the most recent National Health & Nutrition Examination Survey (NHANES) showed 68.9% were aware of their hypertension, 58.4% were treated, but only 31.0% were controlled.

Hypertension is responsible for 35% of heart attacks and strokes, 49% of heart failure, and 24% of premature deaths. Individuals with hypertension also have an increased risk of end-stage renal disease, retinopathy, and aortic aneurysm. For this reason the U.S. Preventive Services Task Force recommends screening adults ages 18 years and older for high blood pressure. And many pharmacies throughout the United States offer blood pressure screening as a service.

Step 1: Planning

Develop a plan. The National Heart, Lung & Blood Institute (NHLBI) has put together a program entitled "Prevent and Control America's High Blood Pressure: MISSION POSSIBLE." This program has specifics that include how to advertise a screening, build partners in the community, provide free education materials that can be downloaded-in short, everything you need to make a screening program for high blood pressure work (see "Web resources").

Step 2: Program specifics

Structure the program. "It's very simple to set up, and it does not require a whole lot of time. You basically just have a sign-in. You can target anybody who is on blood pressure pills," said Marty Feltner, Pharm.D., clinical coordinator, Westgate Kohll's Pharmacy and Homecare, Omaha.

In Kohll's program, taking blood pressure is a routine service rather than a one-time screening. "We treat it just like a prescription. If patients come in and say, 'I want my blood pressure checked,' we put them in line, as if for a prescription. We have a consultation area where we then take their blood pressure and go over any aspect of their care."

Procure the equipment, train the staff. Deborah S. King, Pharm.D., associate professor of medicine, University of Mississippi Medical Center, Jackson, Miss., teaches students in the hypertension clinic. She commented, "They all think, when they get here, that they know how to take blood pressure. Then they realize quickly that they have no clue." Butler University College of Pharmacy & Health Sciences, Indianapolis, uses an 18-step check-off in assessing students' technique. The specific details of accurate blood pressure assessment are spelled out in the American Heart Association (AHA) Scientific Statement. The British Hypertension Society has a Web-based video that can be used for the training and evaluation of observers.

Marra's Pharmacy in Cohoes, N.Y., and Kohll's Pharmacy and Homecare utilize both pharmacists and nurses to take blood pressure. By measuring an individual's blood pressure, Kohll's pharmacists then have an opportunity to perform an intervention if needed.

Selection of appropriate equipment is important for accurate results. Feltner relies on taking blood pressure manually to ensure accurate results. King noted, though, that most clinical trials use devices that measure by using mercury to attain the most accurate results. The latest AHA statement provides information about accuracy of different types of blood pressure monitors. King tempers information provided in the AHA statement with Consumer Reports findings about specific brands. In clinical trials, she uses an electronic device.

It is important to have a repertoire of cuff sizes. Recent demographic data indicate that 42% of all men and 26% of all women aged 40-59 years require a large blood pressure cuff.